PERIMALLEOLAR SUBCUTANEOUS TISSUE PRESSURE EFFECTS OF ELASTIC COMPRESSION STOCKINGS

Purpose: We hypothesized that the clinical benefit of elastic compress ion stockings (ECS) is at least in part due to an increase in subcutan eous pressure that may promote resorption of extracellular fluids, pro viding more efficient diffusion of oxygen and nutrients from the micro circulation to the skin and subcutaneous tissues. Methods: To test thi s hypothesis we designed and standardized a device for measuring subcu taneous pressure in patients. We then measured the supine perimalleola r subcutaneous pressure from a single limb in four groups: group 1 con sisted of control subjects (n = 8); group 2 consisted of patients with varicose veins and superficial venous insufficiency without lipoderma tosclerosis or edema (n = 5); group 3 consisted of patients with deep venous insufficiency and lipodermatosclerosis but without edema (n = 8 ); and group 4 consisted of patients with deep venous insufficiency, l ipodermatosclerosis, and clinically evident edema (n = 8). Measurement s were made at baseline and after application of 20 to 30 mm Hg and 30 to 40 mm Hg ECS. Results: There was no significant difference in the baseline subcutaneous pressure between the three groups without clinic al edema (p > 0.05). Baseline perimalleolar pressure was elevated, how ever, in group 4 patients compared with groups 1, 2, and 3 (p < 0.05). All three groups with chronic venous insufficiency (CVI) (groups 2, 3 , 4) demonstrated increases in subcutaneous pressure with application; of ECS, which was statistically significant in groups 3 and 4. There w as no difference between the increase in perimalleolar subcutaneous pr essure induced by 20 to 30 mm Hg or 30 to 40 mm Hg ECS in groups 3 and 4. Conclusions: Patients with CVI and edema have significant elevatio ns in supine resting perimalleolar subcutaneous pressure compared with control subjects and patients with CVI without edema. Twenty to 30 mm Hg and 30 to 40 mm Hg ECS increased measured perimalleolar subcutaneo us pressure in patients with CVI with and without clinical edema but n ot in control patients. These results suggest the mechanism of benefit of ECS in patients with CVI is due at least in part to an increase in subcutaneous pressure that may act to promote more efficient absorpti on of perimalleolar extracellular fluid.